Senator Joe Lieberman’s latest argument against the public health insurance option struck me strange:
“This is a radical departure from the way we’ve responded to the market in America in the past,” Lieberman said Sunday on NBC’s “Meet The Press.” “We rely first on competition in our market economy. When the competition fails, then what do we do? We regulate or we litigate. … We have never before said, in a given business, we don’t trust the companies in it, so we’re going to have the government go into that business.”
Ezra Klein of the Washington Post thought that was a wierd comment, too:
“What does he think Social Security is? Or Medicare? Or public fire departments?”
To be fair, his list includes responsibilities that the private industry largely shuns (there’s no market for private fire protection), or which the government is the main provider and private industry is a structured alternative (Medicare Advantage) or a supplement (private retirement plans).
The model for the public health insurance option is one where the government isn’t the sole provider, but is one among a range of options. One analogy used by Senator Schumer is public universities, UC-Berkeley being an excellent option alongside private colleges like Stanford. But even there, the public health insurance option is not going to be subsidized like the UC system (although less so, as the protests this week show), nor as dominant in terms of being the real and only option for so many Californians.
Maybe a better analogy for Senator Lieberman is public broadcasting, which he has strongly supported over his years (at least when he was a Democrat). Public radio and television stands alongside traditional private radio and television stations as one of several options. Yes, public broadcasting gets a small subsidy, but it’s tiny compared to its overall budget. It has been structured with different incentives, and thus has been able to respond to market failures: for example, specializing in educational children’s television programming and informational documentaries all of which were unique until the explosion of cable channels; even now, it is an important launching pad for programs. In radio, it has focused on in-depth news, and there’s nothing like it on the dial.
There’s been a lot of online commentary about how the public health insurance option, given all the compromises to come and already made, may not be worth it. We need to still advocate for a public option that has strong negotiating power, that is national in scope, and begins on day one. But even if it is not available to everybody on day one, or doesn’t save all the money that a stronger version does, I do think there are other reasons for it. With a different structure and accountability that the private insurers, it has the real potential to innovate in areas of market failures: Maybe it specializes in really doing the best possible treatment and management of asthma, diabetes, and obesity. Maybe it figures out new ways to provide access to rural populations. Maybe it is just a “safe harbor” for people against continued abuses by private insurers–much like PBS is a safe harbor for parents against TV commercials.
There are many other important issues as well in the health reform debate, from affordability to employer responsibility. But the public health insurance option continues to be a key concept worth fighting for, even with some of the compromises made.